[Aortic Intramural Hematoma: a Challenging Diagnosis]

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Diagnostic Imaging

Background:

• Acute aortic syndrome (AAS) encompasses life-threatening conditions like aortic dissection, intramural hematoma (IMH), and penetrating atherosclerotic ulcers.
• Prompt diagnosis and management are critical for AAS, with differing treatment strategies for Stanford Type A and Type B classifications.

Observation:

• A 75-year-old female presented with acute abdominal pain, a history of cardiovascular conditions, and was on apixaban.
• Imaging revealed an intramural hematoma of the aorta extending from the left subclavian to the inferior mesenteric artery, with ulcer-like projections.

Findings:

• Initial conservative management with blood pressure control for the descending aortic intramural hematoma was unsuccessful.
• The patient underwent successful endovascular aortic repair (TEVAR) for complicated Stanford Type B aortic syndrome.
• The patient experienced a good recovery and was discharged.

Implications:

• Endovascular aortic repair is a viable option for complicated Stanford Type B aortic intramural hematoma when conservative measures fail.
• Timely and accurate diagnosis of AAS is crucial for effective treatment planning.
• This case highlights the importance of considering advanced interventions for aortic pathologies presenting with persistent symptoms.